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Over the past few decades, several recommendations have been published to guide the management of rheumatoid arthritis (RA).1 2 However, successful implementation of these guidelines in clinical practice has lagged behind.3 In 2019, the European Alliance of Associations for Rheumatology (EULAR) published updated recommendations for the management of RA with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biological disease-modifying antirheumatic drugs (bDMARDs).1 Few studies have characterised real-world challenges to effective implementation of RA management algorithms in Asian countries. Leveraging data collected from the Chinese Registry of Rheumatoid Arthritis (CREDIT; see online supplemental materials),4 we sought to examine the degree of concordance between RA management in China and the 2019 EULAR recommendations.
Supplemental material
Patients from CREDIT were eligible for inclusion in the present study if they had newly diagnosed RA based on the 2010 American College of Rheumatology (ACR)/EULAR RA classification criteria, moderate to high disease activity (clinical disease activity index (CDAI) >10) at baseline, without severe extra-articular involvement that may affect treatment strategies. The initial treatment for a given patient was considered consistent with the EULAR recommendations if the patient initiated csDMARD monotherapy. Patients were then followed longitudinally to evaluate whether timely treatment escalation at 3 and 6 months occurred if treatment targets of remission or low disease activity were not achieved. Associations of these outcomes …
Footnotes
Handling editor Josef S Smolen
SJ, NJ and YH contributed equally.
Collaborators We acknowledged contributions from CREDIT team all over China and the HealthCloud Co., Ltd as the system provider.
Contributors SJ, NJ and ML participated in the design of the study. YH, XD, YF, CZ, HL, MY, ZH, PY, HZ, FZ and YoW and other Chinese Registry of Rheumatoid Arthritis coauthors contributed to data collection. SJ, NJ, CW and YaW analysed the data. The manuscript was drafted by SJ and revised by ML, NJ, EH and QW. ML, XT, YZ and XZ supervised the study. All authors approved the final manuscript.
Funding This study was supported by the Chinese National Key Technology R&D Program, Ministry of Science and Technology (2017YFC0907601, 2017YFC0907604 and 2019YFC08040603),CAMS Innovation Fund for Medical Sciences (2019-I2M-2–008) and the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (2019PT330004).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.